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Biomedical subjects

J Y Wan

Publications and source records attributed to J Y Wan.

36 records · Page 2Linked to original sources
PubMed1998

Plasma renin activity is associated with bone mineral density in premenopausal women.

Bone mineral density (BMD), plasma renin activity (PRA) and dietary calcium and sodium were evaluated in 47 Caucasian premenopausal women. All subjects were free of any disorder or medications known to affect calcium or bone metabolism. Those subjects with low PRA (< 1.3 ng/ml) had 4.3% lower BMD at the distal radius (p = 0.03). Other skeletal sites appeared to have lower BMD in subjects with low PRA but these differences were not statistically significant. There was a tendency for the low PRA group to have a lower dietary intake of calcium (p = 0.06) as compared with the normal PRA group (> or = 1.3 and < 4.0 ng/ml). Positive correlations were found between calcium intake and PRA (r = 0.26, p = 0.09); and between calcium/sodium intake and distal radial BMD (r = 0.31, p = 0.04), mid-radial BMD (r = 0.30, p = 0.04), total hip BMD (r = 0.23, p = 0.12) and total body BMD (r = 0.27, p = 0.07). This study provides preliminary evidence that a sodium intake > 3400 mg/day, as evidenced by the suppression of PRA, may affect bone mass and the effect may be modified by the level of calcium intake. Additional research is needed to replicate our findings with a larger sample size.

Adolescent↗
PubMed1998

The prognostic significance of asymptomatic carotid bruits in the elderly.

OBJECTIVE: To determine the association between asymptomatic carotid bruits and the development of subsequent stroke in older adults with isolated systolic hypertension. DESIGN: Retrospective cohort study. SETTING: The Systolic Hypertension in the Elderly Program (SHEP), a 5-year randomized trial testing the efficacy of treating systolic hypertension in noninstitutionalized persons aged 60 years or older. From the original 4,736 SHEP participants, we identified a cohort of 4,442 persons who had no prior history of stroke, transient ischemic attack, or myocardial infarction at randomization. MEASUREMENTS AND MAIN RESULTS: The end point for this ancillary study was the development of a stroke. The average follow-up was 4.2 years. Carotid bruits were found in 284 (6.4%) of the participants at baseline. Strokes developed in 21 (7.4%) of those with carotid bruits and in 210 (5.0%) of those without carotid bruits. The unadjusted risk of stroke among persons with carotid bruits was 1.53 (95% confidence interval [CI] 0.98, 2.40). Adjusting for age, gender, race, blood pressure, smoking, lipid levels, self-reported aspirin use, and treatment group assignment, the relative risk of stroke among persons with asymptomatic carotid bruits was 1.29 (95% CI 0.80, 2.06). Among SHEP enrollees aged 60 to 69 years, there was a trend (p = .08) toward increased risk (relative risk [RR] 2.05; 95% CI 0.92, 4.68) of subsequent stroke in persons with, compared to those without, carotid bruits. However, among enrollees aged 70 years or over, there was no relation between carotid bruit and subsequent stroke (RR 0.98; 95% CI 0.55, 1.76). In no other subgroup of SHEP enrollees did the presence of carotid bruit independently predict stroke. CONCLUSIONS: Although we cannot rule out a small increased risk of stroke associated with bruits in asymptomatic SHEP enrollees aged 60 to 69 years, the utility of carotid bruits as a marker for increased risk of stroke among asymptomatic elderly with isolated systolic hypertension aged 70 years or older is limited.

Aged↗
PubMed1998

Risk factors for colonization with yeast species in a Veterans Affairs long-term care facility.

OBJECTIVES: To assess colonization and serious infection with yeasts and the risk factors that are associated with colonization by these organisms. DESIGN: Monthly surveillance for colonization and infection over a period of 2 years. SETTING: A long-term-care facility (LTCF) attached to an acute-care Veterans Affairs Medical Center. PARTICIPANTS: The 543 men and 10 women in the facility. MEASUREMENTS: Colonization and serious infection rates with yeasts. Analysis of risk factors associated with yeast colonization of residents. RESULTS: Colonization rates were relatively stable during the 2-year period (53+/-1.8% patients colonized per month). Candida albicans was the most common colonizer, found in 35+/-.9% of patients colonized per month. The pharynx was the most commonly colonized site, with 41+/-1.4% of patients per month with pharyngeal colonization. Eighty-four percent of patients remaining in the facility for 3 or more months were colonized by yeast at some time during their stay. Presence of neurogenic bladder, leg amputation, or a low serum albumin were independently associated with yeast colonization; neither diabetes mellitus nor functional status was a risk factor for colonization by yeasts. Only four serious yeast infections in four patients (esophagitis and three urinary tract infections) were found during the 2-year period; all infections occurred in patients who were colonized by yeasts previously. CONCLUSION: In our LTCF, colonization of patients by yeasts occurred commonly in those residents remaining in the facility for 3 or more months. However, serious yeast infections occurred infrequently. It is likely that colonization of residents of LTCFs by yeasts may only become clinically important when the patient is transferred to an acute-care hospital where additional risk factors may allow the development of serious yeast infection.

Aged↗
PubMed1997

Prognostic factors in adult granulosa cell tumor of the ovary.

BACKGROUND: The clinical course of adult granulosa cell tumor of the ovary is characterized by indolent growth tending toward late recurrence. A variety of clinical and pathologic parameters have previously been evaluated for prognostication with inconclusive results. METHODS: The clinical records and tumor sections of 70 patients with adult granulosa cell tumors of the ovary were reviewed. Patients with recurrent tumors (REC) (n = 19) were compared with patients who remained without disease (NED) (n = 51). RESULTS: Significant differences in stage and tumor size were noted between the two groups; however, after logistic regression analysis, only stage remained statistically significant. Pathologic evaluation revealed that Call-Exner bodies occurred more frequently in tumors of the NED patients. Cellular atypia and high mitotic rates were more frequent in the REC group; however, after logistic regression analysis, only atypia remained statistically significant. When early (< 10 years) and late recurring tumors (> 10 years) were compared, statistically significant differences were again noted: early recurring tumors had fewer Call-Exner bodies, higher mitotic rates, and higher degrees of atypia; late recurring tumors were similar to tumors in the NED patients. CONCLUSIONS: Tumor stage and, to a lesser extent, tumor size are the only clinical parameters of prognostic importance in adult granulosa cell tumors. Cellular atypia and, to lesser extents, mitotic rate and the absence of Call-Exner bodies are the only significant pathologic prognosticators. It is difficult to predict early recurrences and impossible to predict late recurrences using these clinical and pathologic parameters.

Adult↗
PubMed1997

Colon cancer with metastasis to the ovary at time of initial diagnosis.

Colon cancer with a synchronous ovarian metastasis is occasionally diagnosed at the time of laparotomy for a pelvic mass. The purpose of this retrospective study is to evaluate the clinical presentation as well as the impact of the type of metastatic spread and surgical intervention on overall survival. We reviewed charts of 23 patients treated between 1980 and 1995. Pain was the initial symptom in 14 patients (61%), with only four patients (17%) complaining of rectal bleeding, but with five patients (22%) complaining of uterine bleeding. At the time of laparotomy, the ovarian capsule was intact in 12 patients. Metastatic disease to the peritoneum was seen in seven patients and to the liver in six patients. On pathological evaluation, the median ovarian tumor size was 10 cm, significantly larger than the median colon tumor size of 4.5 cm. Surgical treatment consisted of colon resection in all but one patient, bilateral or unilateral salpingo-oophorectomy in 22 patients, and hysterectomy in nine patients. Only one patient survived 5 years. Sixteen patients died of colon cancer. The median survival time was 17.8 months, ranging from 1 to 86 months. Tumor size was of no prognostic importance. Median survival time of patients with peritoneal disease (10.8 months) was significantly shorter compared to patients without peritoneal disease (25.2 months). In the presence of liver metastasis, the median survival time was, likewise, significantly reduced from 20.1 months to 8.1 months. In conclusion, macroscopic metastatic disease to the ovary is a poor prognostic factor in colon cancer. In selected patients who can be rendered disease-free by surgery, prolonged survival is possible and an aggressive approach is recommended. Survival of patients with peritoneal disease or liver metastasis is short and a mainly palliative approach is recommended.

Adult↗
PubMed1996

Antimicrobials prescribed for otitis media in a pediatric Medicaid population.

Antimicrobial prescribing patterns for Tennessee Medicaid children having their first case of otitis media (OM) in at least nine months were studied. Tennessee Medicaid claims data for patients under 11 years whose first documented OM diagnosis in 1993 occurred in the fourth quarter and who had had an antimicrobial claim filed within two days of diagnosis were studied to determine antimicrobial prescribing patterns. Of 7357 children meeting the study criteria, 70% were less than three years of age, 65% were Caucasian, and 60% had a rural address. Twenty antimicrobials were prescribed. Amoxicillin was prescribed most frequently (53% of the time), followed by cefaclor; all first-line therapies (amoxicillin, ampicillin, erythromycin-sulfisoxazole, and trimethoprim-sulfamethoxazole) accounted for 64% of the prescriptions, but only one fourth of the costs. The highest use of first-line therapy was associated with children under three years of age; children without prior antimicrobial therapy, recent upper respiratory infection (URI), or recent sinusitis; children seen by emergency department physicians; and children seen by urban physicians. Tennessee Medicaid would have saved +68,250 if first-line therapy had been used for all children having their first occurrence of OM in the fourth quarter alone. The savings to the state were estimated at +300,000 or more in 1993 had first-line therapy been used for most first occurrences of OM in all four quarters plus even a small percentage of the estimated 30,000 remaining repeat OM cases. Amoxicillin was prescribed 53% of the time, and all first-line therapies 64% of the time, for children with their first case of OM in at least nine months. In children without recent antimicrobial therapy, URI, or sinusitis, first-line therapy was still used only 72% of the time.

Age Distribution↗
PubMed1995

Symptoms of depression among female nursing students.

This study examines the extent to which depressive symptoms in female nursing students are affected by specific stressors and coping styles. Three hypotheses were examined for differences in symptoms of depression scores and a model was tested for predicting depression in female nursing students. Responses were gathered from three questionnaires (Hassles and Uplifts Scales, Symptoms of Stress Inventory, and Coping Styles) from 408 female baccalaureate, master's and doctoral students from a major Midwest research university. Symptoms of depression were not significantly different among the students and were as high as a comparative group of stress management clients. Path analysis was used to examine the patterns of stressors (hassles, uplifts, personal and student-related stress), coping (coping styles, habits, quitting school, and drug use), and a biological factor (depression around the menstrual cycle) that predicted symptoms of depression. All hypothesized variables had direct paths to symptoms of depression; the path model explained 58% of the variance. Results from this study support the biological and psychological theories of depression in women and raise important questions of particular relevance to women, nursing students and educators.

Adaptation, Psychological↗
PubMed1995

Tympanic versus rectal thermometry in pregnant women.

OBJECTIVE: To assess the accuracy of the tympanic membrane thermometer for use with pregnant women. DESIGN: Cross-sectional descriptive study. SETTING: A major medical center in the midwestern United States. PARTICIPANTS: Thirty-three hospitalized, afebrile pregnant women. MAIN OUTCOME MEASURES: Tympanic membrane thermometers and glass mercury thermometers were used to measure body temperature at the ear and rectum, respectively. The results were compared using two statistical methods: the Pearson correlation coefficient and a new technique suggested by Bland and Altman (1986). RESULTS: Auditory canal temperature measured by a tympanic membrane thermometer correlated with rectal temperature as measured by a glass mercury thermometer (r = 0.38, p = 0.01). Thus, the tympanic membrane thermometer is acceptable for monitoring the body temperature of pregnant women. However, the device's estimation of rectal temperature is not clinically reliable. CONCLUSIONS: Tympanic membrane thermometers, when applied with direct measures, are acceptable for use with pregnant women. It is not recommended that the rectal estimate mode be used with pregnant women.

Body Temperature↗
PubMed1994

Sexually transmitted diseases, sexual behavior, and cocaine use in inner-city women.

The prevalence of untreated sexually transmitted diseases (STDs) was assessed in a cohort of 372 sexually active inner-city women (92% black, 49% US-born) with no history of injection drug use who were recruited in Brooklyn, New York, in 1990 and 1991. The presence of STDs was assessed via culture, serologic analyses, and medical history. Sexual and drug-use histories were obtained, as was a urine sample for toxicologic analysis. Thirty-five percent of the women had at least one STD (27% Trichomonas vaginalis, 6.8% Chlamydia trachomatis, 5.2% syphilis, 2.4% human immunodeficiency virus (HIV), and 1.4% Neisseria gonorrhoeae). US-born women were more likely than foreign-born (96% Caribbean) women to have an STD (50% vs. 22%; p < 0.001). Among US-born women, 61% of crack and/or cocaine users had an STD as opposed to 34% of non-users (OR = 2.9, 95% CI 1.6-5.5). Recent crack cocaine use was the strongest predictor of syphilis infection (OR = 12.8, p = 0.019), and was reported by each of the seven HIV-positive women. This study, based on a large sample with laboratory confirmation of both STDs and drug use, documents that women who use crack cocaine are at substantially higher risk of contracting an STD than other women. STD/HIV prevention programs in inner cities should target US-born women, particularly crack cocaine users.

Adult↗
PubMed1994

A SAS macro for residual deviance of ordinal regression analysis.

In this paper, a SAS macro is described for calculating the likelihood of the 'saturated' model in the analysis of ordinal regression. The outcome variable is multinomial on an ordinal scale, while the explanatory variables can be nominal or ordinal. Several ordinal regression models may be fitted to the data. One method of testing for the goodness of fit of these regression models is by comparing the residual deviance with the chi 2 distribution. In SAS, PROC LOGISTIC may be used to fit this type of data with proportional odds model. Unfortunately, the residual deviance is not available from the output. Our SAS macro will supplement the SAS output so that the residual deviance test may be carried out. The data from an ongoing HIV study is used as an illustration.

Bias↗
PubMed1994

Colonization and infection with antibiotic-resistant bacteria in a long-term care facility.

OBJECTIVE: To assess colonization and infection with methicillin-resistant Staphylococcus aureus (MRSA), high-level gentamicin-resistant enterococci (R-ENT) and gentamicin and/or ceftriaxone-resistant Gram-negative bacilli (R-GNB) and the factors that are associated with colonization and infection with these organisms. DESIGN: Monthly surveillance for colonization and infection over a period of 2 years. In the second year, an intervention to decrease MRSA colonization by the use of mupirocin ointment was carried out. SETTING: Long-term care facility attached to an acute care Veterans Affairs Medical Center. PATIENTS: A total of 551 patients in the facility were followed for a period of 2 years. MEASUREMENTS: Colonization and infection rates with MRSA, R-ENT, and R-GNB. Analysis of risk factors associated with colonization and infection with these three groups of organisms. MAIN RESULTS: In the first year, colonization rates were highest for MRSA (22.7 +/- 1% patients colonized each month) and R-ENT (20.2 +/- 1%) and lower for R-GNB (12.6 +/- 1%). After introduction of decolonization of nares and wounds with mupirocin, the rate of MRSA colonization fell significantly to 11.5 +/- 1.8%, but rates remained unchanged for R-ENT and R-GNB. Risk factors for MRSA colonization included the presence of wounds and decubitus ulcers. For R-ENT, the presence of wounds, renal failure, intermittent urethral catheterization, low serum albumin, and poor functional level were significant. For R-GNB, intermittent urethral catheterization, chronic renal disease, inflammatory bowel disease, presence of wounds, and prior pneumonia were significantly associated with colonization. Overall, of infections caused by known organisms, 49.6% were due to MRSA, R-ENT, or R-GNB, and 50.4% were due to susceptible organisms. Infections were more commonly due to R-GNB (21.1% of all infections) than to R-ENT (8.3%) or MRSA (4.6%). The most common infections were urinary tract infections (42.9% of all infections) and skin and soft tissue infections (31.9% of all infections). Risk factors for MRSA infections were diabetes mellitus and peripheral vascular disease, for R-GNB infections were intermittent urethral catheterization and indwelling urethral catheters, and no one factor was associated with R-ENT infection. CONCLUSIONS: In our long-term care facility, colonization with resistant MRSA and R-ENT was more common than R-GNB, but infections were more often due to R-GNB than R-ENT and MRSA. Several host factors, which potentially could be modified in order to prevent infections, emerged as important in colonization and infection with these antibiotic-resistant organisms.

Aged↗
PubMed1993

Psychological distress, drug and alcohol use as correlates of condom use in HIV-serodiscordant heterosexual couples.

OBJECTIVE: To investigate the relationship between psychological distress, alcohol, drug and condom use in HIV-serodiscordant heterosexual couples. METHODS: Structured interviews were conducted to collect demographic information, detailed data on psychological distress, drug and alcohol use and sexual behavior. RESULTS: Analyses were based on 106 pairs of sexually active discordant couples. Significant differences among heterosexual condom users and non-users varied according to gender and HIV serostatus. Affect domains of interpersonal sensitivity and hostility were significant, as were the variables of regular drug or alcohol use and combining sex with drugs or alcohol. Employment was strongly associated with condom use in HIV-negative women whose regular sexual partners were HIV-positive men. CONCLUSION: The risk of vaginal sex without condoms in HIV-serodiscordant heterosexual couples may be reduced by specific psychological counseling and attention to drug and alcohol use as risk factors. Further research on the effect of employment of HIV-negative women is required.

Adolescent↗
PubMed1992

Age-related decline of disc rim area in visually normal subjects.

Optic disc parameters and axial lengths were measured in 81 visually normal young and elderly white adults (young [n = 41]: 27.2 +/- 5.7 years versus elderly [n = 40]: 68.8 +/- 8.4 years) using Rodenstock Optic Disc Analyzer and A-scan sonography. Axial lengths correlated positively with optic disc parameters (Spearman correlation analysis: rim area: P = 0.042, disc area: P = 0.052, and cup volume: P = 0.010). Older subjects had a shorter axial length (23.09 +/- 1.02 mm) and smaller disc rim area (1.171 +/- 0.338 mm2) than younger subjects (23.60 +/- 1.15 mm and 1.325 +/- 0.314 mm2; Mann-Whitney U test: P = 0.011 and P = 0.013, respectively). While both axial length and disc rim area declined with age (0.011 mm and 0.003 mm2 per year; Spearman correlation analysis: P = 0.032 and P = 0.020, respectively), the cup-to-disc and rim area-to-disc area ratios appeared to remain relatively constant throughout adult life. The age-related decline of disc rim area is consistent with histologic evidence of age-related decline of ganglion cell axons. The rim area-to-disc area ratio seems less affected by age, and is thus a better parameter to isolate age-related change from disease-related change of optic nerve in a longitudinal follow-up of diseases involving the optic nerve head.

Adolescent↗
PubMed1992

Maximum likelihood estimation and testing of a poisson regression model.

A Poisson regression model is proposed for the analysis of incidence rates presented in a two-way table classified by two categorical variables. It is shown that the likelihood function is the same as that using Glasser's exponential covariate model. An algorithm is given to solve the maximum likelihood estimates of the regression parameters. The model is evaluated via deviance and the method is illustrated with an example. Some extensions of the model are discussed.

Adult↗
PubMed1991

Visual field global indices in patients with reversal of glaucomatous cupping after intraocular pressure reduction.

The authors investigated visual field changes in 28 eyes of 28 adult patients with early-to-moderate chronic open-angle glaucoma (COAG) in whom reversal of glaucomatous disc cupping was documented by computerized image analysis (Rodenstock Optic Nerve Head Analyzer) after intraocular pressure (IOP) reduction from 29.3 (+/- 5.9) to 19.4 (+/- 4.3) mmHg over 34.8 (+/- 24.8) weeks. Humphrey Statpac global indices (mean deviation and pattern standard deviation) improved in direct proportion to the magnitude of IOP reduction even after controlling for the possible influences of learning effect, short-term fluctuation, reliability, duration of IOP reduction, age, and pupil size. The mean visual field global indices (mean deviation and pattern standard deviation) improved in patients with IOP reduction of 40% or greater, in statistically significant contrast to no improvement of mean global indices with IOP reduction less than 35%. The beneficial effect of IOP reduction is apparent in COAG patients with topographical evidence of reversal of cupping.

Adult↗
PubMed1991

Intraocular pressure-dependent retinal vascular change in adult chronic open-angle glaucoma patients.

Intraocular pressure (IOP)-dependent retinal vascular changes were investigated in 33 eyes of 33 adult chronic open-angle glaucoma (COAG) patients by measuring major retinal vascular calibers at the optic disc border before and after mean (+/- standard deviation) IOP reduction from 35.3 (+/- 7.2) to 16.5 (+/- 4.7) mmHg for 11.2 (+/- 13.5) weeks. Both mean arterial and venous calibers were significantly reduced (P less than 0.0001 for each), from 87.8 (+/- 14.2) and 128.3 (+/- 20.8) microns at high IOP to 82.0 (+/- 13.8) and 121.4 (+/- 18.5) microns at low IOP. Arterial and venous caliber decreases correlated positively with magnitude of IOP reduction (r = 0.503, P less than 0.01 and r = 0.555, P less than 0.001, respectively). While the IOP-dependent retinal arterial caliber change was highly significant in patients 55 years of age or younger (r = 0.636, P less than 0.01) and in the overall study group, it was not significant in patients older than 55 years (r = 0.205, P greater than 0.1). Age seems to be more influential than magnitude of IOP reduction in patients older than 55. Thus, diminished IOP-dependent retinal arterial caliber change in the elderly may be one factor contributing to the higher incidence and prevalence of glaucoma in this population.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

A survey of attitudes about maternal serum screening for fetal chromosome abnormalities in women 35 years of age and older.

We asked two groups of women their opinion on prenatal diagnosis and maternal serum screening (MSS): group 1 comprised women who had undergone a prenatal diagnostic procedure (amniocentesis or chorionic villus sampling) for advanced maternal age (>/=35 years) and group 2 women who had undergone MSS and were 30-34 years old. Women in group 1 were found significantly less likely to choose MSS over prenatal diagnosis than were women in group 2. The sensitivity of MSS and the age-related risk of chromosome abnormalities influenced opinions on whether to choose MSS or prenatal diagnosis. In both groups, the majority stated that they would accept MSS over prenatal diagnosis, if their obstetrician recommended it.

Adult↗